Monthly Archives: September 2017

According to the U.S. National AIDS Strategy report, about 1 in 5 American adults smoke. Among adults living with HIV, the number of people who smoke is 2 to 3 times greater. The report also states that smoking can cause health risks specifically for people who are living with HIV. For example, smokers with HIV are at higher risk (as compared to nonsmokers with HIV) of developing smoking-related cancers, bacterial pneumonia, COPD, heart disease, and oral candidiasis (thrush).

Furthermore, previous research found that HIV-positive smokers lose years of life to cigarettes as compared to nonsmokers with HIV.

If all of that wasn’t enough to convince gay and bi men with HIV to kick the habit, a new study published in The Journal of the American Medical Association narrows the range of research, focusing specifically on projected lung cancer deaths.

The researchers found that nearly 25 percent of people who adhere well to anti-HIV medications but continue to smoke will die from lung cancer. Among smokers who quit at age 40, only about 6 percent will die of lung cancer. The authors also found that people with HIV who take antiviral medicines but who also smoke are from 6 to 13 times more likely to die from lung cancer than from HIV/AIDS.

“Quitting smoking is one of the most important things that people with HIV can do to improve their health and live longer,” Travis Baggett, MD, MPH, of the MGH Division of General Internal Medicine and coauthor of the study, said in a recent press release. “Quitting will not only reduce their risk of lung cancer but also decrease their risk of many other diseases, such as heart attack, stroke and emphysema.”

Rates of new sexually transmitted infections (STIs) are much higher among men who have sex with men (MSM) taking Truvada (tenofovir disoproxil fumarate/emtricitabine) as pre-exposure prophylaxis (PrEP) than among other MSM. More research is needed, however, to determine whether starting PrEP leads to higher STI rates among MSM.

Publishing their findings in the journal AIDS, researchers conducted a meta-analysis of 18 studies of MSM in which new STI diagnoses were reported. Five of the studies included MSM given PrEP, and 14 were conducted with MSM who were not given PrEP. (One study, the PROUD study, included both a group given PrEP immediately and a group given PrEP on a deferred basis and thus fell into both the PrEP and the non-PrEP categories of studies.)

The researchers found that the rates of new diagnoses of STIs among MSM given PrEP were 25.3 times greater for gonorrhea, 11.2 times greater for chlamydia and 44.6 times greater for syphilis, compared with the rates among MSM not given PrEP. After repeating the analysis but excluding studies conducted before 1999, the researchers found that the results were similar.

Looking to parse apart the contributing factors to the higher rate of STI diagnoses among MSM given PrEP, the meta-analysis’s authors theorized that the regular STI testing that is part of taking PrEP might have led to a higher rate of STI detection. A greater number of sex partners and a higher rate of condomless sex among those given PrEP might also have contributed to their higher STI diagnosis rate.

The study is limited by the fact that, except in the case of PROUD, the researchers compared different populations of MSM from study to study. They also compared groups that tested for STIs at different frequencies and used different variations of STI tests. Additionally, the PrEP studies specifically sought out participants engaging in high-risk sexual behaviors, while the other studies might have had different criteria with regard to sexual risk taking. However, participants in many of the non-PrEP studies were indeed recruited based on some level of reported sexual risk taking.

A pill that protects against the human immunodeficiency virus (HIV) can be safely used by young men who have sex with men, according to a new study.

In a diverse group of teen boys at high risk for HIV infection, pre-exposure prophylaxis (PrEP) in the form of a pill that combines the drugs emtricitabine and tenofovir disoproxil fumarate was well tolerated, researchers found.

“I do hope clinicians increase their comfort with being able to provide PrEP to adolescents,” said lead author Sybil Hosek, a clinical psychologist and HIV researcher at Cook County Health and Hospitals System’s Stroger Hospital in Chicago.

She hopes the new data will be submitted to the U.S. Food and Drug Administration (FDA) and will encourage the agency to approve the pill for use by younger people. The pill is currently approved for HIV prevention in adults.

The drug was first approved by the FDA in 2012 as Truvada, which was marketed by Gilead. Trials found that the drug reduced the risk of HIV infection by over 90 percent.

But little evidence was collected on its use among gay and bisexual adolescent males, who are among those most at risk for HIV infection.

For the study, researchers enrolled 78 gay and bisexual young men, ages 15 to 17, from six U.S. cities. The participants all tested negative for HIV at the start of the study, but were at high risk for an infection.

Participants received a counseling session about HIV risk, plus access to daily doses of PrEP for the next 48 weeks.

Overall, 47 participants completed the study.

Only three adverse events occurred that were possibly related to PrEP, the researchers found.

“I think the safety piece is important,” Hosek told Reuters Health. “It was well tolerated. We didn’t see many complaints about side effects. We did not see many adverse events.”

The researchers also didn’t find an increase in sexually risky behaviors over the study period.

Three young men did become infected with HIV, however. Blood samples suggest they were taking less than two doses of PrEP each week at the time of infection.

The rate of HIV infection in the study was 6.4 cases per 100 people per year, which is about twice as high as the rate seen among men ages 18 to 22 years enrolled in a similar trial, the researchers write in JAMA Pediatrics.

“I shudder to think what the (HIV infection) rate would be if we didn’t offer PrEP,” said Hosek.

She said the high rate of HIV infections is likely due to poor adherence. While more than 95 percent of the young men had evidence of the preventive medication in their blood during the first 12 weeks of the study, by week 48 only about 15 percent of participants had detectible levels of the drug.

Low adherence to medications is a common problem with adolescents, said Hosek.

Dr. Renata Arrington-Sanders writes in an editorial accompanying the new study that making PrEP a success among gay and bisexual adolescents will require effort.

“This work suggests that adolescents may require additional visits than what is currently recommended by national guidelines and suggests a need for multiple team members to address structural barriers to accessing PrEP, assist with youths’ interpretation of HIV risk, and support self-efficacy to swallow and adhere to medications,” writes Arrington-Sanders, of Johns Hopkins University in Baltimore.

Hosek agreed, calling for doctors to be more connected to their young patients on PrEP.

“Clinicians should not be afraid to see adolescents more frequently, maintain a connection with the adolescents and keep them engaged,” she said.

“Double discrimination” and loneliness put bisexual individuals at “higher risk for poor mental health outcomes,” according to a recent study out of American University. The study compared the mental health of bisexual men and women to that of gay men, lesbians and heterosexuals.

“Bisexual people face double discrimination in multiple settings — bisexual people are often invisible, rejected, invalidated [and] stigmatized in the heterosexual community as well as the traditional LGBTQ communities,” Ethan Mereish, an assistant professor at American University and the study’s lead author, told NBC News. “Given that isolation and discrimination, bi people might be experiencing increase factors that might make them more lonely or isolated.”

Previous research has shown that lesbian, gay and bisexual individuals broadly face higher rates of mental health issues than their straight counterparts. Yet there are mental health disparities that the bisexual community faces at higher rates than even gays and lesbians. That said, the American University study surveyed 503 bisexual adults ranging in age from 18 to 64 to hone in on their unique minority stressors and the effects they have on mental health.

Greenesmith, whose organization has compiled a number of studies and reports that point to the relatively poor health of the bisexual community, said this latest study makes it “even more clear that the bisexual community needs tailored mental health services.”